Perspectives in Disease Prevention and Health Promotion
Update: Childhood Poisonings -- United States

Deaths from unintentional ingestion of potentially poisonous
substances among children under 5 years of age have decreased from
a
high of 456 in 1959 to a low of 57 in 1981 (1,2). Mortality data,
however, underestimate the magnitude and public health impact of
the
childhood poisoning problem (Table 1). Data from the National
Hospital Discharge Survey (NHDS), conducted by the National Center
for
Health Statistics (NCHS), show that, for each year between 1979 and
1982, an estimated 20,000 children under 5 years of age were
hospitalized in the United States for ingestion of potentially
toxic
substances. Therefore, for each child death from unintentional
poisoning, approximately 300 children were hospitalized. Medicinal
substances accounted for 45% of the hospitalizations, and
nonmedicinal
substances accounted for the remainder. Of the medicinals, aspirin
and other analgesics accounted for the most hospitalizations
(11.8%).
Of the nonmedicinals, products containing lead accounted for an
additional 11.7% of hospitalizations.

The number of children hospitalized for unintentional
ingestions
also underestimates the public health impact of childhood
poisonings.
The U.S. Consumer Product Safety Commission (CPSC) estimates from
its
National Electronic Injury Surveillance System (NEISS) that, in
1983,
over 110,000 children under 5 years of age were treated in hospital
emergency rooms for ingesting potentially toxic substances (3).
Thus,
for each child hospitalized for unintentional poisoning, an
estimated
six to eight children are treated in emergency rooms and released.
The American Association of Poison Control Centers estimates from
poison-control reports about 1.4 million childhood poison exposures
in
1983; 91% of these occurred in the home (4). For each child
treated
in an emergency room for poisoning, about 13 other poison exposures
to
children are reported to poison-control centers. It is unlikely
that
even these high figures reflect all poisonings. Many poisonings
are
not reported to poison-control centers because they are either
treated
in a physician's office or not treated at all.
Reported by Southeastern Regional Office, US Consumer Product
Safety
Commission, Atlanta, Georgia; Chronic Diseases Div, Center for
Environmental Health, CDC.

Editorial Note

Editorial Note: March 17-23, 1985, marks the 24th annual Poison
Prevention Week. It is sponsored by the Poison Prevention Week
Council (PPWC), a coalition of 31 national organizations
representing
industry, consumer groups, health professionals, government, and
the
media. Its purpose is to reduce unintentional poisoning among
children by alerting Americans to this preventable problem.

The Poison Prevention Packaging Act (PPPA) of 1970 requires
that
certain potentially hazardous drugs and household products be sold
in
child-resistant containers. Currently, 15 product categories are
covered by the PPPA, including controlled drugs, turpentine, some
petroleum distillates, and prescription drugs. Since the PPPA was
implemented, reported incidents of children ingesting regulated
products have markedly declined. The PPPA is credited with
preventing
an estimated 86,000 ingestions between 1974 and 1981 (5). Data
from a
CPSC study indicate that, for regulated products, rates for
emergency-room visits for ingestion by children under 5 years of
age
declined from 5.7/1,000 children under 5 years of age in 1973 to
3.4/1,000 in 1978. For unregulated products, the rate increased
from
1.8/1,000 to 1.9/1,000 during the same period (6).

Although unintentional ingestions and deaths among children
have
declined considerably since PPPA was enacted, the childhood
poisoning
problem persists. Possible causes include failure to correctly use
child-resistant packaging, improper storage of poisonous
substances,
ignorance of proper emergency procedures when ingestion occurs, and
failure of some pharmacies to dispense prescription drugs in
child-resistant containers. A recent survey of pharmacies in one
area
determined that nearly one-third did not dispense prescription
drugs
in child-resistant containers (7).

The PPWC and its member organizations advocate a broad-based
approach to preventing childhood poisoning. This approach will be
enhanced as better information about the circumstances surrounding
the
poisoning events become available. This information should provide
clues for further environmental interventions.

References

National Office of Vital Statistics, National Center for Health
Statistics. Vital statistics of the United States, 1959. Vol
II. Mortality statistics for the United States and each state.
Washington, D.C.: U.S. Department of Health, Education, and
Welfare, Public Health Service, 1961.

New York State Attorney General's Office. Investigation of
pharmacies' compliance with the Poison Prevention Packaging
Act,
1984. New York: New York State Attorney General's Office,
1984.

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